Bowel cancer increasing among younger Australians, but decreasing in older population

Researchers from the University of New South Wales have reported that the incidence of bowel cancer, which includes colon and rectal cancer, has increased by up to 9 percent in people under 50 from the 1990s until now. The study, ‘Exposure to Trace Elements and Risk of Skin Cancer: A Systematic Review of Epidemiologic Studies,’ published recently in Cancer Epidemiology, Biomarkers and Prevention also found bowel cancer incidence is falling in older Australians.

The researchers examined all recorded cases of bowel cancer from the past 40 years in Australians aged 20 and over. Previous studies assessing bowel cancer incidence in young Australians have also documented an increase in the younger age group.This trend is also being seen internationally. A study from the United States suggests an increase in bowel cancer incidence in people aged 54 and younger. The research shows rectal cancer incidence increased by 3.2 percent annually from 1974 to 2013 among those aged age 20-29.

Bowel cancers are predicted to be the third most commonly diagnosed cancer in Australia this year. In 2018, Australians have a one in 13 chance of being diagnosed with bowel cancer by their 85th birthday.

The study also found bowel cancer incidence is falling in older Australians, which they claim is due, in part, to the efficacy of the National Bowel Cancer Screening Program, targeted at those aged 50-74. Bowel cancer screening acts to reduce cancer incidence, by detecting and removing precancerous lesions, as well as reducing mortality by detecting existing cancers early.

This is important, as bowel cancer has a good cure rate if discovered early. In 2010 to 2014, a person diagnosed with bowel cancer had a nearly 70 percent chance of surviving the next five years. Survival is more than 90 percent for people who have bowel cancer detected at an early stage. It is estimated that if coverage rates in the National Bowel Screening Program can be increased to 60 percent, around 84,000 lives could be saved by 2040.

Although the study was not designed to identify why bowel cancer is increasing among young people, there researchers said that there are some factors that could underpin their findings:

The increase in obesity parallels that of bowel cancer, and large population-based studies have linked obesity to increased cancer risk.

Unhealthy lifestyle behaviours, such as increased intake of highly processed foods (including meats), have also been associated with increased bowel cancer risk. High quality studies are needed to explore this role further.

Alcohol is also thought to be a contributor to increasing the risk of bowel cancer.

However, the note that evaluating a cancer screening programme for the general population requires a careful analysis of the potential benefits, harms, and costs. A recent Australian study modelled the trade-offs of lowering the screening age to 45. It showed more cancers would potentially be detected. But there would also be more colonoscopy-related harms such as perforation (tearing) in an extremely small proportion of people who require further evaluation after screening.

A lower screening age would also increase the number of colonoscopies to be performed in the overstretched public health system and therefore could have the unintended consequence of lengthening colonoscopy waiting times for people at high risk.

Most importantly, healthcare professionals need to ensure eligible Australians participate in the current evidence-based screening program. Only 41 percent of the population in the target 50-74 age range completed their poo tests in 2015-2016. The test is free, delivered by post and able to be self-administered.

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